States Can't Afford Medicaid Expansion -- Neither Can Patients

Sally Pipes
, ContributorI cover health policy as President of the Pacific Research InstituteOpinions expressed by Forbes Contributors are their own.

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This fall's midterm election ballot just got a little longer in Utah. In mid-April, progressive activists announced that they'd gathered enough signatures to force a November referendum on Medicaid expansion.

Utah isn't the only red state flirting with extending free government health insurance to able-bodied, childless adults. Within weeks, activists in Idaho will surpass the number of signatures required for their own ballot referendum. Groups in Nebraska just launched a signature-gathering campaign, too.

If voters choose to expand Medicaid, they'll surely regret it. Enlarging the program won't improve the health of the poor. But it will strain state budgets -- and take money away from other important public priorities, like education and infrastructure.

Congress originally established Medicaid to provide health coverage to low-income elderly, blind, and disabled people. The entitlement also covered pregnant women and mothers with young children.

Obamacare greatly expanded the program. The health law directed all states to offer Medicaid to residents earning up to 138 percent of the federal poverty level -- or about $16,700 for an individual this year.

But in 2012, the Supreme Court ruled that mandatory expansion was unconstitutional. The ruling gave states the option to expand -- or not -- as they wished.

To date, 31 states and the District of Columbia have done so, sweeping more than 15 million new enrollees into the program. Today, Medicaid is the largest health insurance provider in the United States, with 74 million beneficiaries.